摘要：

 目的 探讨高龄慢性硬膜下血肿患者的多学科诊疗模式，以及该模式下钻孔引流术的有效性和安全性。方法 2014年12月至2018年12月经多学科诊疗模式下钻孔引流术共治疗37例高龄（≥80岁）慢性硬膜下血肿患者，术后根据Bender分级评价临床症状和神经功能缺损程度、头部CT评价手术疗效、KPS评分评价生活质量，记录围手术期相关并发症发生率。结果 手术相关并发症包括非张力性气颅（19例占51.35%）、硬膜下积液（5例占13.51%）、低颅压（2例占5.41%）和癫痫发作（1例占 2.70%）；高龄相关并发症为新发肺部感染（1例占2.70%）、血压异常（3例占8.11%）、血糖升高（2例占 5.41%）、冠心病急性发作（3例占8.11%），无围手术期死亡病例。与手术前相比，术后临床症状和神经功能好转（Z=6.198， P=0.000），术后CT显示总有效率为86.49%（32/37）；随访期间KPS评分 ≥60分，CT 显示总有效率为96.43%（27/28）。结论 多学科诊疗模式可以优化高龄慢性硬膜下血肿的诊疗流程，具有针对性地制定个体化手术方案，在该模式下行钻孔引流术治疗高龄慢性硬膜下血肿安全、有效，可改 善预后、降低病死率。

关键词: 血肿, 硬膜下, 慢性, 引流术, 老年人, 80以上, 诊疗模式, 医师

Abstract:

Objective To explore the multi-disciplinary diagnosis and treatment mode of elderly patients with chronic subdural hematoma (CSDH), and the effect and safety of trepanation and drainage under this mode. Methods A total of 37 elderly patients with CSDH (≥ 80 years old) were treated by trepanation and drainage under multi-disciplinary team (MDT) model from December 2014 to December 2018. Summarized the perioperative management process of CSDH in the elderly patients under MDT model, and observed its complications and prognosis. Bender grade was used to evaluate the clinical symptoms and neurological deficits, CT was used to evaluate the curative effect, and Karnofsky Performance Status (KPS) was used to evaluate quality of life. Results Operation-related complications of 37 patients included non-tension pneumocephalus (19 cases, 51.35% ), subdural effusion in (5 cases, 13.51% ),
intracranial hypotension (2 cases, 5.41% ) and epilepsy (1 case, 2.70% ). The age-related complications included new pulmonary infection (1 case, 2.70% ), abnormal blood pressure (3 cases, 8.11% ), elevated blood sugar (2 cases, 5.41%) and acute coronary diseases (3 cases, 8.11%). There was no perioperative death. The clinical symptoms and neurological function was improved significantly after operation (Z = 6.198, P = 0.000). Postoperative CT showed that the total effective rate was 86.49% (32/37). During the follow-up period, the KPS was over 60 score, and CT showed that the total effective rate was 96.43% (27/ 28). Conclusions MDT model can optimize the diagnosis and treatment process of CSDH, and formulate detailed individualized treatment plan. Trepanation and drainage under the MDT model for the treatment of elderly patients with CSDH is helpful to improve prognosis and reduce mortality.

Key words:  Hematoma, subdural, chronic, Drainage, Aged, 80 and over, Practice patterns, physicians'